Perspective               

New Coverage Guideline for Injected Drugs

In December 2000, Congress changed a Medicare law to provide for coverage of self-injectable drugs when they are administered under a doctor's care and "are not usually self-administered by the patient." But despite the legislation, the government did not take any action to implement the new coverage guideline.

Finally, in May 2002, the Centers for Medicare and Medicaid Services (CMS) issued a guideline. The guideline instructs Medicare Carriers, companies that review Medicare claims for the government, to cover injectable drugs that are self-administered less than 50 percent of the time.

The Center for Medicare Advocacy, a consumer advocacy group, says that CMS' interpretation of the law penalizes and discriminates against people with Alzheimer's and other debilitating conditions. CMS' guideline instructs Medicare Carriers to make coverage determinations on a "drug-by-drug" basis rather than a patient-by-patient basis. Therefore, if most people can self-administer a drug, Medicare will not cover the drug even if there are certain people who cannot self-administer the drug because of their debilitating illness.

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